Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions?

BACKGROUND: The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. METHODS: Echocardiographic data obtained from 150 patients (mean age 56 ±â€¯16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. RESULTS: Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. CONCLUSIONS: We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.

Linking Chronic Inflammation with Cardiovascular Disease: From Normal Aging to the Metabolic Syndrome.

The metabolic syndrome (MetS) is a cluster of clinical disorders including an unhealthy body habitus with a large waistline, dyslipidemia, glucose intolerance and hypertension. It is known that these disorders not only increase the chances of developing type 2 diabetes mellitus (T2DM), but also cardiovascular disease (CVD). Furthermore, the co-occurrence of all these risk factors known as the MetS is linked to pathways sharing common underlying mediators and mechanisms. Though insulin resistance has been considered as the root of the problem to explain the conglomerate of metabolic abnormalities within this syndrome; new evidence points to several pro-inflammatory cytokines, reactive oxygen species and free fatty acid intermediates might play an even greater role in regulating a series of intracellular signaling pathways sustain as well as perpetuate the development of the MetS and its CVD complications. Since having a diagnosis of MetS confers not only a 5-fold increase in the risk of T2DM, but also a 2-fold risk of developing CVD over a period of 5 to 10 years; it is vital to better recognize the mechanisms by which the MetS is associated with such adverse outcomes. Therefore, it is the purpose of this review to address (1) how inflammation modifies insulin sensitivity, (2) known factors believed to contribute to this process, and (3) new concepts of inflammatory markers in regulating the development of MetS and its individual components.

Changes in Mitral Annular Ascent with Worsening Echocardiographic Parameters of Left Ventricular Diastolic Function.

Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa). Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD). Results. Patients with normal LV diastolic function were younger (41 ± 13 years) than patients with LVDD (stage 1: 61 ± 13 years; stage 2: 57 ± 14 years; and stage 3: 66 ± 17 years; p = 0.156). LV ejection fraction decreased in patients with stage 2 LVDD (63 ± 17%) and was further reduced in patients with stage 3 LVDD (28 ± 21; p = 0.003). Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and stage 3 LVDD patients. Our results highlight the importance of atrioventricular coupling, as MAa motion seems to reflect changes in left atrial pressure. Additional studies are now required to better examine atrioventricular interactions and electromechanical coupling that might improve our assessment of LV diastolic function.